This revised application is using the NIMH "R-34" treatment development award mechanism and is entitled "treatment of PTSD in cardiac patients". The goal of this application is to develop a treatment for posttraumatic stress disorder (PTSD) symptoms that are caused by the emotionally traumatic experience of having had a myocardial infarction (Ml). Ml is an acute, life-threatening event that may be accompanied by a feeling of helplessness or fear. Therefore, it can qualify as emotionally traumatic according to the DSM-IV-TR definition, and may elicit symptoms of PTSD. Indeed, recent studies report that significant PTSD symptoms exist in 10-20% of patients with cardiovascular illnesses, and that these symptoms are associated with nonadherence to medications and poor medical as well as psychiatric outcome. PTSD symptoms are highly comorbid with depression post-MI. Yet, PTSD symptoms are not usually targeted in efforts to treat patients post-MI, and classic depression treatments are not as helpful in patients who had an Ml as compared with depressed patients without Ml. The treatment of PTSD may therefore be a promising new approach to improve psychiatric as well as medical outcome in patients who had a myocardial infarction. Effective treatment options for PTSD do exist, but they were not studied in Ml survivors. Existing treatments need to be substantially modified in order to be used in this population of medically ill individuals who are adjusting to a new post-MI reality (as opposed to a single-incident trauma survivor who is expected to adjust back to his or her pre-trauma functioning). The plan of this proposal is to develop a modified trauma-focused cognitive-behavioral treatment for PTSD symptoms that occur in Ml survivors and test it in a randomized, controlled study. We will evaluate the safety as well as the potential benefits of this approach. A full efficacy trial is expected to follow this pilot study if the results are encouraging.